| Description | A guidance document on the arrangements in Scotland for implementing foundation programmes from August 2005 |
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| ISBN | |
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| Official Print Publication Date | |
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| Website Publication Date | May 28, 2004 |
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Modernising Medical Careers
Foundation Programmes
May 2004
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Dear colleague
The UK-wide strategy
Modernising Medical Careers (MMC) was born out of the significant and long-standing need for reform of the SHO grade. As it has developed its scope has broadened and it now heralds important changes for doctors in all training grades. It also includes a commitment to improved arrangements for non-consultant career grade doctors.
MMC has at its heart securing quality of care for patients. It paves the way for more flexible and efficient training opportunities which will deliver the doctors that Scotland needs fit for practice in the 21st century. It will take several years to introduce but when complete it will ensure that more service is delivered by trained doctors and less, as is the case now, by doctors in training.
To meet these goals training must be efficient, managed and delivered through high-quality, independently assured training programmes compatible with the Working Time Regulations. These new arrangements must have the capacity to meet both the needs of the health service and of individual doctors. MMC must ensure that the talents and expertise of our doctors are realised and used to best effect enabling new graduates to pursue a fulfilling and rewarding career. MMC will also accommodate international graduates who we welcome to train in Scotland.
The first stage of this new, modern approach to your medical career is through a
Foundation Programme. We will begin the commissioning of these programmes from August 2005.
We believe that MMC is a new and exciting opportunity which will support the professional development of doctors. There are challenges but we will prepare for them and closely monitor progress. Postgraduate deans, educational and clinical supervisors will work with you and our partners across the health service and the professions to ensure that these new arrangements are a success.
We wish you well.
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Dr E M Armstrong
Chief Medical Officer | Professor Stuart G Macpherson
Chairman, Scottish MMC Delivery Group |
What is the
Modernising Medical Careers programme?
To date little information has been made available to students and trainee doctors about MMC and
the
Foundation Programmes (FP) which begin the new training pathways. This document has been designed to answer some of the questions you may have.
The policy statement
Modernising Medical Careers was published by the four UK Health Departments in February 2003. It set out key principles for the reform of postgraduate training and was followed up with a fuller description of these new arrangements in
The Next Steps published by the Health Departments in April 2004. Both are readily available (see page 6). It is important to emphasise that
Modernising Medical Careers is a major programme of reform which will take several years to conclude. It is not restricted to
Foundation Programmes but will, in due course, include progressive specialist and general practitioner training programmes. Stage-by-stage implementation of MMC will be carefully managed to ensure that transition to the new arrangements benefits both trainee doctors and patients.
What are Foundation Programmes?
One of the key proposals is the introduction of a two-year Foundation Programme.
A Foundation Programme:
will be delivered though the four Scottish deaneries to standards set by the competent authorities (The General Medical Council and The Postgraduate Medical Education and Training Board) who will be jointly responsible for approving Foundation Programmes.
will comprise approximately 30 doctors (15 in each year) each pursuing their own individual programme;
will include a broad range of experience in mainly acute care settings and a clear aim to provide experience in mental health as well as in general practice;
usually consists of 6 placements each of 4 months duration;
ideally contains no single placement of less than 4 months duration;
must be supervised:
Educational supervision is likely to be by a senior career grade doctor, known as the
Foundation Tutor, and usually employed for this purpose for one session per week. Tutors will be responsible for career guidance, appraisal, assessment, mentoring, provision of formal education experiences and will be trained for the purpose. They will manage the FP, be concerned with recruitment to it and arranging placements.
Clinical supervision is ordinarily by a consultant or general practitioner trainer.
In addition:
All medical students wishing to undertake an FP in Scotland must apply through the Scottish Foundation Allocation Scheme (SFAS) (see page 6);
Current PRHO and SHO posts will be progressively reconfigured to create the FPs; and
Scotland wide mechanisms for trainee appraisal and assessment, which will be in accordance with the requirements of the competent authorities, are being developed and will be applied.
Frequently Asked Questions on Foundation Programmes
What is a Foundation Programme?
You will spend the first two years of your postgraduate training in a
Foundation Programme (FP). In this programme you will develop the generic competences relevant to any branch of medicine including for example: communication skills; and managing the acutely ill patient. You will work in varied clinical environments and will contribute to service delivery as part of the clinical team.
What will be different between FPs and the current PRHO year?
The first year of your FP will, initially, be much like the current PRHO year. However there will be some differences. Unlike the current arrangements, where doctors may hold independent appointments, the new placements will be educationally co-ordinated within programmes. FPs will be based on rotational placements, ideally with no placement being less than 4 months' duration. You will be accepted into one FP.
A broad range of programmes have been developed. Details will be available on the (SFAS) website (see page 6);
What happens in the second Foundation year?
The curriculum for the second year is still being developed. It is likely to be made up of placements of six-months' or four-months' duration. Your Tutor will discuss with you the options that will be available. It is not necessary to apply again for the second year of the FP if you have been accepted into the first year.
Your second year placements will build on the competences acquired during your first year and you will keep the same Foundation Tutor.
Will there be any change to my salary?
In your first year you will be paid as a PRHO and in your second year as a first year SHO.
What is a Foundation Tutor?
One of the major problems with existing training is the lack of sufficient help available to you for career development. Providing this is a cornerstone of these changes. Each trainee will have a named Foundation Tutor responsible for the FP they join. The Tutor will be responsible throughout the two year programme for career guidance, appraisal, assessment, mentoring and for ensuring the provision of formal education experiences. They will manage the FP, be concerned with recruitment to it and with arranging placements.
How will I get into a foundation programme?
The Scottish Foundation Allocation Scheme (SFAS) is the route to a two-year FP. It will enable you to identify the programme to which you may wish to apply. It has been developed from the current Scottish PRHO Allocation (SPA) scheme.
Will I be placed in a single hospital?
It is unlikely that your FP will be confined to a single hospital. For example, one programme may contain in any year three four-month placements and one of these may be located in a different hospital or setting. In addition, some programmes will have placements in mental health, general practice or in remote and rural settings. The programme will provide a diversity of experience in varied settings underpinned by robust educational management. This will improve organisation, supervision and continuity of your training.
Will it be as easy to work in different deaneries as it is now?
You are currently free to apply to any UK deanery for PRHO posts and this will continue to be the case for FPs. Under the new system your two year programme will ordinarily be within a single deanery. However, individualised programmes which may involve more than one deanery may, in due course, be possible and will be organised through your Postgraduate Dean and Foundation Tutor. If you choose to apply outside of Scotland, then you will have to obtain details of the relevant matching or appointment schemes from the regional postgraduate deanery.
What assessment processes will be used in the foundation programme?
A major difference is that there will be continuous in-training assessment. Scotland wide mechanisms for appraisal and assessment are being developed and will be applied. The curriculum for the FP is being finalised: lists of generic core competencies are being developed - you will be assessed against these at various stages. The emphasis of assessment will shift from theory or knowledge based assessment towards skills/ competency based assessment.
What about study leave?
The arrangements for study leave across the two years of the FP - particularly the first year - will require review.
When will I get full registration?
It is envisaged that doctors graduating from UK medical schools will be eligible for full registration half way through the FP, that is, at the end of the first year. These arrangements are currently under review by the GMC.
Will I be able to change my mind, or location? Will I still be able to go overseas?
It is natural, as doctors mature and develop that many may wish to change direction or modify their training. However, FPs are by their nature designed to deliver generic competences in a breadth of settings so they should be able to meet the educational needs of all doctors. Some students and doctors may be concerned that
the planned training structure of FPs will make change within the two year programme difficult. This is a matter you should discuss with your Foundation Tutor or Postgraduate Dean.
You could exit a programme to go either elsewhere in the UK or overseas. However, you may find it much easier and, in training terms, coherent to complete an FP based in one deanery. Whether or not training undertaken abroad in place of the second foundation year will be recognised, has yet to be determined by PMETB.
What if I have to take time out or reduce my training commitment?
Less-than-full-time-training is becoming
increasingly popular and widespread. If you wish to have a career break or seek less-than-full-time-training you should raise this matter with your Foundation Tutor or Postgraduate Dean.
Who's responsible for all this?
And what happens if it goes wrong?
In the first instance you should raise problems with your Foundation Tutor or Postgraduate Dean. The General Medical Council (GMC) and the Postgraduate Medical Education and Training Board (PMETB) are the statutory bodies which will be jointly responsible for supervising, quality assuring and approving FPs.
The GMC is also responsible for registering you, both provisionally and fully. Their vision is set out in their documents
The New Doctor and
Good Medical Practice. The GMC is also responsible for the new Specialist and General Practitioner Registers.
When commissioned the new PMETB will be responsible for quality-assuring and approving all other postgraduate training. It will bestow Certificates of Completion of Training (CCTs) for those who complete the specialist and general practitioner training programmes that will in due course follow on from FPs.
What further changes will happen?
Will these affect me, even if I'm not in a Foundation Programme?
In due course, the introduction of new post-foundation specialist and general practitioner training programmes will entail further changes to current SHO training and to general practice and higher specialist training. The arrangements here have yet to be finalised. However, the intention is to have a system of progressive, seamless specialist and general practice training programmes to CCT level which follow on from the two year FPs. Arrangements will be made to enable those who have not completed an FP to access the new system.
What action should I take now?
If you wish to find out more you should consult the resources below in order to gain a deeper understanding of these changes. Your first port of call should be with the postgraduate deanery. You may also wish to contact the Medical Royal Colleges and Faculties and/or your local BMA representative.
Remember, the arrangements which will be in place from August 2005 are currently being developed but they will be confirmed well before you enter each stage of training. We are confident that the educational opportunities that will be available will be of high quality.
We will ensure that you are kept informed as the arrangements to commission FPs are confirmed.
How do I find out more?
Publications:
Other useful websites:
Contacting the Scottish MMC Delivery Group
We would be pleased to hear from you. Your views can help shape and guide the development of these plans. Should you wish to pass any comments to the Group you can do so by contacting:
mmc@scotland.gsi.gov.uk